Major Organs of Digestion

and Absorption
 Digestive System

1. digestion
- Digestion is the breakdown of food
into small molecules, which are then
absorbed into the body
2. absorption.
 2 PARTS OF
DIGESTIVE SYSTEM
1. The gastrointestinal (GI) tract
(alimentary canal)
- is a continuous tube with two
openings, the mouth and the anus.
- It includes the mouth, pharynx,
esophagus, stomach, small
intestine, and large intestine. into
blood or lymphatic vessels.
2. Accessory organs
include the teeth and tongue,
salivary glands, liver, gallbladder,
and pancreas.
A. Stomach
    1. general anatomic regions
       a. cardia
       b. fundus
       c. body
       d. pyloric region
- stomach is important in the process of
physical digestion
- rugae are undulations in stomach wall to
help grind
- pyloric sphincter regulates entry into the
duodenum .
- chyme is liquified digested material
four major secretory cells
a. chief cells
 - pepsinogen
    activation of pepsinogen by low pH to form pepsin
    pepsin is a protease for protein digestion
b.   parietal cells
  - HCl
     secretion enhanced by histamine via H2 receptors
    Tagamet blocks H2 histamine receptors to inhibit HCl secretion

  - intrinsic factor

     binds to and allows B12 absorption in intestines
c. G-cell
  - gastrin hormone
    gastrin activates gastric juice secretion & gastric smooth
muscle “churning”
     gastrin activates gastroileal reflex which moves chyme from
ileum to colon
d. mucus cell
 - protective role of mucus against acids and digestive enzymes
B. Gastric Activity

    1. major action in the stomace are

secretion of gastric juice & contraction of
smooth muscle
    2. three major  mechanisms of gastric
regulation
       a. cephalic phase
         - initiated by parasympathetic
activation (vagal innervation)
         - . cortical (smell, thoughts, etc.)
activation of medulla
         - medulla activates gastric juice
secretion
         - medulla activates gastrin secretion
         - medulla activates smooth muscle
“churning”
b. gastric phase
- food mass and chemicals trigger
parasympathetic reflex
- enhance parasympathetic
activation of stomach
- activate & enhance emptying of
chyme into duodenum
C. intestinal phase
C. Small Intestine
    1. major site of chemical
digestion & absorption
    2. approx. 21 ft long/ 1inch
diameter
    3. three major segments
       a. duodenum  ~10 inches
       b. jejunum  ~8 ft
       c. ileum  ~ 12 ft
Histology
- mucosa has intestinal glands (cavities)
for secretion of intestinal juice
- mucosa also has circular folds, villi &
microvilli for increased surface area
- “brush border” has many enzymes
embedded in plasma membranes
 * several carbohydrate-digesting
enzymes
* peptidases
* nucleosidases
* enterokinase is released by epithelial
cell “shedding”
            
I. Large Intestine
    1. major function to absorb water and
eliminate indigestable matter
    2. major structures
       a. cecum with vermiform appendix
       b. ascending, transverse, descending
colon
       c. sigmoid colon, rectum
       d. haustra are pouches in wall of large
intestine
          i. haustral churning is sequential
movement of contents from one haustra to
the next
          ii. gastrocolic reflex is rapid peristalsis
in LI triggered by food in stomach
3. normal bacterial flora colonize
colon
       a. vitamin K synthesis by E.
coli bacterium
   4. vermiform appendix
       a. lymphatic structure
attached to cecum
Accessory organs
Pancreas
    1. approx 1.5L/day pancreatic secretions
produced
    2. secretions enter duodenum via two
pancreatic ducts
    3. many different components in these
secretions
       a. NaHCO3 – buffers pH of chyme
       b. pancreatic amylase
       c. trypsinogen, chymotrypsinogen,
carboxypeptidase
         - trypsinogen activated by enterokinase to
become trypsin
         - . trypsin acts on other proteases to
activate them
       d. lipases
       e. ribonucleases
 Liver
- is largest gland in body
- overall function to “filter” and process nutrient-rich
blood delivered to it
Functions:
1.receives nutrient-rich blood from SI via the hepatic
portal vein
2.many functions to liver besides aiding in digestion
3. regulates carbohydrate metabolism
  a. glucose secretion into blood/absorption from blood
into glycogen storage
b. regulated by insulin & glucagon (endocrine review)
4.regulates many aspects of lipid metabolism
       a. chemical digestion of fatty acids (B-oxidation)
for entry into Krebs cycle
       b. cholesterol synthesis
5. detoxifies blood
Nutrient Absorption
    1. carbohydrates
       a. enzymatically digested to form
monosaccharides (glucose, fructose,
galactose)
       b. absorbed in SI by active transport
or facilitated diffusion
       c. enter blood capillary in villi, then
directed to hepatic portal vein
    2. proteins
       a. enzymatically digested to amino
acids or di- and tri-peptides
       b. absorbed in SI by active transport
or facilitated diffusion
       c. enter blood capillary in villi, then
directed to hepatic portal vein
lipids
       a. enzymatically digested to
short or long chain fatty acids
       b. suspended in SI in form of
micelles with bile salts
       c. micelle formation aids lipid
diffusion into SI epithelial lining
       d. inside epithelial cells, lipids
bound into chylomicrons for
transport
       e. chylomicrons transported to
lacteal villi;  then into lymphatics
and then to venous blood
 
 The treatment of food in the digestive
system involves the following seven
processes:

1. Ingestion is the process of eating.

2. Propulsion is the movement of food
along the digestive tract. The major
means of propulsion is peristalsis, a
series of alternating contractions and
relaxations of smooth muscle that lines
the walls of the digestive organs and that
forces food to move forward.
3. Secretion of digestive enzymes and
other substances liquefies, adjusts the pH
of, and chemically breaks down the food.
4. Mechanical digestion is the process of physically breaking
down food into smaller pieces. This process begins with the
chewing of food and continues with the muscular churning
of the stomach. Additional churning occurs in the small
intestine through muscular constriction of the intestinal
wall. This process, called segmentation, is similar to
peristalsis
5. Chemical digestion is the process of chemically breaking
down food into simpler molecules. The process is carried out
by enzymes in the stomach and small intestines.
6. Absorption is the movement of molecules (by passive
diffusion or active transport) from the digestive tract to
adjacent blood and lymphatic vessels. Absorption is the
entrance of the digested food into the body.
7. Defecation is the process of eliminating undigested
material through the anus.
NGT CONCEPT
 TYPES OF NASOGASTRIC TUBES

1. levin and
2. Salem Sump tubes
1. levin tube
- consists of a single lumen with
multiple distal perforations, through
which gastric contents can be
aspirated or fluids / medications can
be infused.
2. Salem Sump tube is a double lumen
tube.
- The main lumen (which is similar to
the Levin tube) is used for aspiration
and infusion
- the secondary (smaller and blue
colored) lumen serves to vent the
tube to the atmosphere, preventing
excessive vacuum at the distal tip
and allowing continued evacuation
of the stomach contents
 Standard Sizes:

Children - Fr 5-12
Adult - Fr 13-18
NASOGASTRIC TUBE INSERTION
 
Indications
• Gaining access to the stomach and its contents.
• drain gastric contents,
• decompress the stomach,
• obtain a specimen of the gastric contents, or
introduce a passage into the GI tract.
• allow you to treat gastric immobility, and bowel
obstruction.
• allow for drainage and/or lavage in drug
overdosage or poisoning.
• In trauma settings, NG tubes can be used to aid
in the prevention of vomiting and aspiration, as
well as for assessment of GI bleeding. NG tubes
can also be used for enteral feeding initially.
Contraindications

• severe facial trauma

(cribriform plate disruption), due to
the possibility of inserting the tube
intracranially. In this instance, an
orogastric tube may be inserted
• Pregnant ladies: In pregnancy
(especially up to 7 months), enema
should be strictly avoided as it
increases the risk of abortion
substantially.
• n extreme condition of piles and
rectum ulcers.
• intestinal obstructions.
• Very weak people (after conditions
of acute illnesses or otherwise)
Complications

• aspiration
• and tissue trauma.
 Universal precautions:

• Gloves must be worn

• and if the risk of vomiting is high, the
operator should consider face and eye
protection as well as a gown.
• Trauma protocol calls for all team
members to wear gloves,
• face and eye protection
NASOGASTRIC TUBE INSERTION 
• Is the insertion of a tube through a
nose and into the stomach
Objectives:

• To remove secretions and gaseous substances from the GIT

to prevent abdominal distention (DECOMPRESSION ).
• To instill nutritional supplements or feedings into the
stomach for patients who are unable to swallow fluids
( GAVAGE).
• To apply intestinal pressure by means of an inflated
balloon to prevent internal hemorrhage ( COMPRESSION ).
• o irrigate the stomach in cases of active bleeding or
poisoning
( LAVAGE ).
• To obtain a specimen of gastric contents for laboratory
studies
• ( When pyloric and intestinal obstruction is suspected ).
• To determine the amount of pressure and motor activity in
the GI tract ( Diagnostic Studies )
ASSESSMENT:

• Bowel sounds
• Abdominal distention
• vomiting
• Assess patients mental status or
ability to cooperate with the
procedure
PLANNING:
1. Prepare the Equipments
• Salem sump or Nasogastric tube
• Water proof pad or towel
• Hypoallergenic tape
• Water soluble KY jelly
• Penlight
• Glass of water
• Straw . Connecting tube
• Emesis basin . Stethoscope
• Asepto syringe . Suction apparatus
• Rubber band . Gloves
• Normal saline solution
2. Prepare the Patient:
• Explain the procedure
• Tell the patient that he may feel some
discomfort in his nose and that the procedure
may cause him to gag or shed tears.
• Have the patient practice mouth breathing,
panting and swallowing to facilitate easy
insertion of the tube.
• Establish hand signal techniques he can use
when he needs a rest during the insertion
• Remove dentures that do not fit well.
• Determine the size o the tube to be use and
whether or not the tube is attached to
suction.
IMPLEMENTATION:

1. Remove the NGT from the package

2. Measure the Length of NGT to be inserted using either of
the following methods:
– Measure distance by holding distal end of the tube to
the tip of the nose to the earlobe
– Hold the distal end of the tube from the earlobe to the
xiphoid process
• to measure the approximate length of the tube that will
reach the stomach
3. Place an adhesive tape to indicate total length you have
measured
• this will serve as marker to indicate that the approximate
length of the tube has already been inserted
4. Prepare the tube .Curve end of the tube around fingers
and hold for a few seconds
• to facilitate tube passage
5. Put on gloves
6. Lubricate the first 2 to 3 inches of the tube with
KY jelly.( Never use mineral oil or petroleun
jelly)
• lubricants reduces friction between the mucous
membrane and the tube, thus prevent nasal
injury to the nasal passages.(An oil based
lubricant such as petroleum jelly will not
dissolve and could cause respiratory
complications it enters the lungs.A water
soluble lubricant dissolves if the tube
accidentally ewntes the lungs)
 
7. have the patient hold his head up straight.
Then carefully insert the tube into the nostril
with better airflow
• the passage of the tube is facilitated by
following the normal contour of the body
 
8. Aim the tube toward the patient’s ear and downward,
gently passing it into the oropharynx
9. When the tube reaches the patient nasopharynx, you will
feel some resistance. Tell the patient to lower his head
slightly.
• Flexed head partially occlude the airway and the tube to
less likely to enter the trachea
10. Rotate the tube about 10 degrees toward the nostril
• this prevent the tube from entering the patient mouth
11. Check emesis basin on the bedside table in front of the
patient. (prepared before the start of the procedure )
• to catch for vomitous in cases the patient will vomit
12. Hand him a glass of water with straw and tell him
to swallow . As the patient swallow slowly advance
the tube.( Do not force to insert the tube than the
patient can swallow) .
• swallowing closes the epiglottis that facilitates the
passage of tube into the esophagus.
 
13. If the patient is in respiratory distress, the tube
may be in the bronchus. Withdraw the tube
immediately.
• to prevent complication
14. Stop advancing the tube when you reach the
adhesive tape or other marking used.
15. Confirm placement of the tube by:
– aspirating stomach contents with an asepto
syringe, check the pH
• aspirated gastric contents indicates that the tube is
in the stomach.
 16. Inject 5-10 cc of air into the tube as you auscultate
for a whooshing sound over the epigastric region.
• air can be detected by a whooshing sound entering
the stomach
• Submerging the distal end of the tube in a water
• if there is bubbling it means that the tube is in the
bronchus
• If the measures do not confirm proper placement
request for a chest x-ray
17. Secure end of the tube with tapes or with a
clip
• to prevent air from unnecessary entering the
tube causing abdominal distention
 
18. Secure the tube by taping it to the bridge of
the client’s nose
• if the client has oily skin, wipe the nose first
with alcohol.
• Cut the tape, and split it in lengthwise
 
19. Unglove hands
20. Loop the tube, secure it with a rubber band
and attach to patient’s gown
• to reduce discomfort from the weight of the
tube
21. Pin the end of the tube above the stomach
• to prevent reflux of gastric content
22. Attach NGT to connecting tubing and
solution apparatus as ordered. If there is no
order, keep tip of the tube closed.
23. Chart procedure and reactions of the patient.
24. Do after care
• Inspect the nost
• ril for discharge and irritation
• Clean the nostril and tube with moistened
cotton tipped applicators
• Apply water-soluble lubricant to the nostril if it
appears dry or encrusted
Nursing Considerations:

1. Partially pre-freezing the tube can

ease its passage.
2. Infants can suck on a pacifier during
the procedure.
3. Don’t rely on a cuffed endotracheal
tube to prevent passage into the
trachea – be sure and confirm
placement using the above methods.
BOWEL DIVERSION OSTOMIES
Colostomy
Temporary or permament
opening of the colon through
the adominal wall

Indications : cancer of the

rectum or rectosigmoid area,
perforating diverticulum, trauma.
ILEOSTOMY

• Opening from the ileum or small

intestine through the abdominal
wall. Bypasses the entire large
intestine.

Indications : ulcerative
colitis, Crohn’s disease, trauma,
cancer, birth defect.
STOMA
- Part of the colon that is brought
above abdominal wall in an ostomy
and becomes the outlet for
discharge of intestinal contents
1. LOOP STOMA
Temporary large stoma where loop
of bowel is brought to abdominal
surface and opening created in
anterior wall of bowel to provide
fecal diversion
2. END STOMA
- One stoma formed from the
proximal end of the bowel with the
portion of the GI tract either
removed (permanent) or sewn
closed (Hartmann’s pouch) and left
in the abdominal cavity.
3. DOUBLE BARREL STOMA
- Bowel is surgically severed and two
ends are brought out onto the
abdomen as two separate stomas.
The proximal end is the functional
stoma. The distal end is
nonfunctioning, called a mucus
fistula. Intended as a temporary
diversion in cases where resection
is required due to perforation or
necrosis.
Good stoma
Bad stoma
What else should you expect to see
when you examine the stoma?

1. There should be mild to moderate

edema in the first 5-7 days post-op.
Severe edema may indicate
obstruction of the stoma, allergic
reaction to food or gastroenteritis.
2. Blood oozing from the stomal
mucosa when touched is normal
because it is so vascular.
NURSING CONSIDERATIONS:

1. Tension at the stoma site where it is sutured

to the skin can create poor healing or necrosis
of the stomal skin edge and retraction of the
stoma into the abdomen. This is called
Mucocutaneous separation
2. It is a gradual process because the patient
experiences grief over the loss of a body part
and an alteration in body image.
3. Adjustment period is individualized.
4. Patients are concerned about body image,
sexual activity, family responsibilities and
changes in lifestyle
TYPES OF OSTOMY POUCH
APPLIANCE
1. One piece disposable pouch
- odor-proof plastic pouch with an
attached adehsive or karaya seal.
• Open-end pouch - drainaable
disposable pouch with a closure
clamp attached to skin barrier, may
be used permanently ro temporarily
• Closed end pouch - may come in a kit
with adhesive seal, belt tabs, skin
barrier or
2. Two piece disposable pouch
- Drainable pouch with separte skin
barrier that permits frequent
changes and minimizes skin
breakdown.
3. Reusable pouch
- Typically made of sturdy,
hypoallergenic plastic that comes
with separate cutom-made
facelate and O - ring.
STOMA CARE

1. the first step is looking at the stoma,

progressing to assisting with emptying
and cleaning, and then to changing
the pouch.
2. If the patient cannot progress to the
point of willingness to learn, a
caregiver must be taught pouch
change procedure and care until the
patient is ready to learn
3. Pouch change is best performed
before eating because the stoma is
less active.

4. Ideally, the pouch should be changed

every 5 to 7 days, but if it leaks it
must be changed immediately.
5 . Pouches are made of odorproof plastic,
but if the bag is not cleaned adequately
when emptied or if a leak has developed,
there will be an odor.
6 . There are products on the market to
eliminate odor…drops that can be put in
the bag at changing or cleaning, odor
neutralizing sprays when the pouch is
changed, or bags with built in charcoal
filters.
7. Remind your patient how important it is to
have them examine the peristomal skin for
any sign of breakdown. It is so much easier
to prevent this rather than heal the skin!
8. Patients may bathe or shower with or
without the pouch. Patients may swim with
the pouch in place as well.
9. Routinely wash with warm water. Soap
is likely to leave a residue that can
cause dermatitis and decrease the
adhesiveness of the pouch. If soap is
used be sure to avoid ones with oils and
rinse thoroughly.
10. Commercial cleansing wipes are
convenient when away from home as
long as they don’t contain lanolin or
emollients. Tucks works well.
Points to Consider:

1. The opening should be about 1/8 inch larger than

the stoma.
2. Teach your patient to empty the pouch when it is
no more than 1/3 full and to cleanse the pouch from
the bottom with a squeeze bottle filled with water
(one piece unit). The two piece unit can be
snapped off, washed and snapped back on.
3. Change the entire unit (one or two piece) every 4-
7 days depending on stability of seal.
4. Remind your patients to not lift anything over 10
pounds for the first 6 to 8 weeks after surgery,
otherwise they may resume normal activities
COLOSTOMY IRRIGATION:

Basic Concept: Irrigating a colostomy is a

procedure similar to that of enema which is
done for the main purpose of distending the
bowel sufficiently to stimulate peristalsis and
therefore evacuation of bowel.
Objectives:
1.To empty colon the colon of its content of feces, gas
and mucus
2.To cleanse the lower intestinal tract
3.To establish regular pattern of evacuation so that
the normal life activities may be pursued.
enema

• is the procedure of introducing

liquids into the rectum and colon via
the anus.
Types of Enema
Enema varies according to the temperature of the
water.
1. Cold Enema:
50of-65of (or 10oC-18oC). It is helpful in decreasing
fever and it is also beneficial in inflammatory
conditions of the colon especially in cases of
dysentery, diarrhea, ulcerative colitis and
hemorrhoids.
Caution:
a. Don't turn on the Enema nozzle fully. Take 10-
15m. time undergoing Enema practice.
b. In the case of ulcers and hemorrhoids, take 10gm
of dried Neem leaves (powder) boiled in 1 liter of
water, & then allow to cool. Strain this water and
then use. To buy this invaluable herb for enema
2. Warm Enema:

97oF-100oF(or 36oC-38oC) is
recommended for general fitness
and well being once a week. It
helps to cleanse the rectum of the
accumulated tassel matter. This is
not only the safest system for
cleaning the bowel but also
improves the peristaltic
movement of the bowels and
thereby relieves constipation.
3. Hot Enema:

104oF-115oF (or 40oC-45oC) is beneficial on sudden occasions

such as stoppage / obstruction of tassel matter and intestinal
gas in which you may also feeling be mentally uncomfortable.
• Hot Water Enema is beneficial in relieving irritation and pain
due to inflammation or rectum, painful hemorrhoid. It also
helps leucorrhoea in women.
• It is also beneficial in general abdominal pain, abdominal pain
due intestinal gas and pain of kidney, liver and spleen.
Caution:

a. The quantity of water used should be ¼ - ½ liter and the

enema duration should be for 10mins.

b. In the case of ulcers and hemorrhoids, boil 10 gm of dried

neem leaves (powder) in 1 litre of water, & then allow to cool.
Strain this water and then use.
4. Graduated Enema:

In graduated Enema the amount and

temperature of water is slowly decreased
up to the 15th day. It is started with 2 liter
of water and decreased by 125 ml per day
up to 125 ml. on 15th day. In the case of
temperature , it is slowly decreased from
100o F to 70o F (i.e. 2o per day). It is
highly beneficial in cases where intestines
are over dilated and it improves the
intestinal function.
Types of enema:

1. Cleansing enema
• Prevent the escape of feces during surgery.
Prepare the intestine for certain diagnostic tests
such as x-ray or visualization tests (e.g.
colonoscopy). Constipation or impaction.
• Cleansing enema: (high): Given to cleanse as
much of the colon as possible. Left lateral
position to the dorsal recumbent position and
then to the right lateral position during the
administration so that the solution can follow the
large intestine. The solution container is usually
held 12 to 18 inches above the rectum because
the fluid is instilled farther to clean the entire
bowel.
• Cleansing enema (low): Cleanse the rectum and
sigmoid colon. Maintains a left lateral position
during administration.
2. Carminative enema:
• Distends the rectum and colon with gas
released from the enema solution. For an
adult, 60 to 80 mL is instilled.

3. Retention enema:
• Introduces oil or medication into the
rectum (types):

4. Return-flow enema:
Alternating flow of 100 to 200 mL of fluid
into and out of the rectum and sigmoid
colon stimulates peristalsis. Repeated five
or six times until the flatus is expelled and
abdominal distention is relieved.
Commonly used enema solutions
• Hypertonic: 90 to 120 mL of solution (e.g.
sodium phosphate).
• Hypotonic:  500 to 1,000 mL of tap water.
Distends colon, stimulate peristalsis, and
softens feces. Effective in 15 to 20 minutes.
Fluid and electrolyte imbalance; water
intoxication.
• Isotonic: 500 to 1,000 mL of NS. Distends
colon; stimulates peristalsis, and softens
feces. Effective in 15 to 20 minute. Adverse
effects: Possible sodium retention.
• Soapsuds: 3-5 mL soap to 1,000 mL water.
Irritates mucosa, distends colon. Effective in
10 to 15 minutes. Adverse effects: Irritates
and may damage mucosa.
ENEMA -
Is The installation of solution into the
rectum and sigmoid colon
Objectives :
• Bowel preparation or diagnostic tests or
surgery to empty the bowel of fecal
content.
• delivery of medication into the colon
• To soften the stool
• To relieve gas
• To promote defecation and evacuate feces
from the colon
ASSESSMENT:

• Verify Doctors order- the kind and

temperature of enema, amount and time to
give, purpose of enema.
• Assess client for any rectal pathology.
• Assess vital signs to establish baseline data.
• determine clients condition and age
• Determine when the client last had a bowel
movement and the amount, color and
consistency of the feces
• Assess for abdominal distention.
• Assess the client’s ability to use the toilet.
Bed pan or commode chair.
• Assess the diet of the client.
• Know instructions of pre-packaged enemas.
PLANNING:
 
• gather equipments needed
• enema can/container
• tubing t the connect the container to
the rectal tube
• clamp
• rectal tube of correct size
• lubricant
• bath thermometer
• bath thermometer
• enema solution
• bath blanket
• water proof pad/ cotton draw sheet
• tissue wipes
• bed pan or commode
• clean gloves
• kidney basin
• additional blanket when needed
• Recall of related principles
• Explain the procedure to the patient
• Provide privacy
IMPLEMENTATION
 
1. Place rubber sheet and cotton draw sheet or water
proof pas under the buttocks of the patient
• to prevent soiling of the bottom sheet
 
2. Drape patient with bath blanket
3. Position the patient in Sims left lateral position
• to expose the anus
4. Open clamp. Run some solution to connecting
tubing and rectal tube to expel air in tubing, close
clamp.
• Air installed into the rectum although not harmful,
causes unnecessary distention
5. Wear gloves
6. Lubricate 5 cm ( 2 inches) of the rectal tube
• lubrication facilitates insertion , thus minimize trauma of
sphincter
7. Lift upper buttocks
• to ensue good visualization of the anus
8. Instruct the patient to breath through the mouth and to
relax the anal sphincter
• allows patient relaxation and readiness
9. Insert the lubricated tip smoothly and slowly into the
rectum directing it toward the umbilicus
• the angle follows the normal contour of the rectum
10. Insert the tube 7-10 cm ( 3-4 inches) for adults, 5-7 cm
( 2-3 inches for children ( 1 – 1.5 inches ) for infants.
• Insertion to this Pont places the tip of the tube beyond
the anal sphincter into the rectum.
11. If resistance is encountered at the internal
sphincter, ask the client to take a deep breath then
run a small amount of solution through the tube
• to relax and internal anal sphincter
12. If resistant persists, withdraw the tube, and
report the resistance to the Nurse in change and
the physician
13. Slowly administer the enema solution
14. raise the solution container ( 12-18 inches above )
and open the clamp to the allow the fluid flow.
• The higher the solution container is held above the
rectum, the faster the flow and the greater the
force in the rectum.
15. If the client complains of fullness or pain, sue
the clamp to stop the flow for 30 seconds.
Restart at a slower rate.
• Rapid infusion can cause colon distention and
cramping. Administering the enema slowly and
stopping the flow momentarily decrease the
like hood of intestinal spasm and premature
ejection of solution.
16. When the correct amount of fluid has been
instilled or when the client has the urge to
defecate. Close the clamp and remove the
rectal tube from the anus.
17. Place the rectal tube in a paper as it is withdrawn.
18. Apply firm pressure over the anus with tissue wipes or
press the buttocks together to assist retention of enema.
Ask the client to remain lying down. Encourage the client
to hold enema for as longs as possible
• it is easier to retain the enema when in lying down.
19. Remove gloves
• Assist the client to defecate
– bedpan
– commode
– toilet bowl
– if specimen is required use bedpan 
20. .Make patient comfortable Do
after care
21. Wash hands
22. Chart
• amount, color, consistency of feces
• presence of unusual constituents
• relief of discomforts ( flatus,
abdominal distention)
 MYTHS about Enema

• Myth #1: It is Difficult

Reality: Quite contrarily, it is one of the
easiest methods of thorough colon
cleansing. Following the instructions as
provided in the enema instruction
booklet will make you aware how
wonderfully easy the procedure is.
Myth #2: It is Habit Forming
Reality: In nature cure, patients who were
given enema for months did not take
even a day to leave it or live without it.

Myth #3: It Weakens the Intestine

Reality: It never weakens the intestine and
rectum; instead taking enema rationally
activates and strengthens them
NURSING Considerations:

1. In enema, water plays an important role and we

should always use safe water for colon cleansing.
Unfiltered, chlorinated water harms the colon
lining and kills good microbes.
2. Chemicals should be avoided in the use of enema
because they irritate the colon tissues. When we
use chemicals, some of it stays in the blood stream
and loads up the work of the liver. Water should be
filtered, preferably with a carbon based shower
filter or a reverse osmosis system for best results.
3. When undergoing an enema, the process should
be slow and one should not rush to end up the
process soon. Mostly people can take 1-3 quarts
of water into the colon but it should be done
slowly - about one cup per minute.

4. The temperature of water also plays an

important role; so don't take in the water too
cold because it can bring in lot of needless pain;
on the other hand,

5. if the water is too hot, it might harm the

sensitive tissues of the colon.
 “

“The genuine
knowledge originates
in direct experience”
THANK YOU